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Risk of coronary heart disease in adulthood according to BMI at age seven years. The estimates are adjusted for sex and cohort (Danish or Finnish), estimated by Cox regression based on restricted cubic splines with age as the underlying time scale and truncated to depict the inner 98% of the BMI distribution. The dashed line shows the estimates without adjustment for birth weight, the bold line shows the estimates with adjustment for birth weight and the dotted lines show the 95% confidence limits for the adjusted estimates. doi:10.1371/journal.pone.0014126.g002
Source publication
Low birth weight and high childhood body mass index (BMI) is each associated with an increased risk of coronary heart disease (CHD) in adult life. We studied individual and combined associations of birth weight and childhood BMI with the risk of CHD in adulthood.
Birth weight and BMI at age seven years were available in 216,771 Danish and Finnish i...
Contexts in source publication
Context 1
... expected, there was a highly significant positive association between BMI at seven years and the HR for CHD, also after adjustment for birth weight (p,0.0005). The association appeared monotonic and slightly non-linear (p = 0.03) (Figure 2). However, as seen in Figure 1, adjustment for BMI at seven years of age in the association between birth weight and the HR for CHD changed the main estimates for birth weight only minimally, and the significance level of the birth weight-CHD association remained the same after adjustment. ...
Context 2
... relative importance of the two factors for later CHD risk appears to be of similar magnitude. We observed that the risk increase was about 20% for children with a birth weight at the 5 th percentile (2.5 kg) or with a BMI of the 95 th percentile (17.7 kg/m 2 ) compared to children with median birth weight and median BMI, respectively ( Figure 1 and Figure 2). Children with a combination of low birth weight and relatively high BMI had a risk increase of CHD of 44% (95% CI: 30% to 59%) (Figure 3). ...
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Citations
... The data from literature show, that in adult patients this cardiovascular risk is greater in people with severe obesity in comparison to moderate obesity [19]. In a cohort of Danish and Finnish subjects, each increase in BMI z-score at 7 years of age (equivalent to a 1.5 to 2.5 kg/ m 2 increment) was associated with a 5%-10% greater risk of coronary heart disease in adulthood [20]. In few studies conducted among teenagers with severe obesity, it was shown that they have a worse cardiometabolic risk profile including increased numbers of risk factors such as higher BP, dyslipidemia, diabetes mellitus, hyperglycemia, or hyperinsulinemia [9,[11][12][13][14][15][16][17][18][19][20][21][22][23]. ...
... In a cohort of Danish and Finnish subjects, each increase in BMI z-score at 7 years of age (equivalent to a 1.5 to 2.5 kg/ m 2 increment) was associated with a 5%-10% greater risk of coronary heart disease in adulthood [20]. In few studies conducted among teenagers with severe obesity, it was shown that they have a worse cardiometabolic risk profile including increased numbers of risk factors such as higher BP, dyslipidemia, diabetes mellitus, hyperglycemia, or hyperinsulinemia [9,[11][12][13][14][15][16][17][18][19][20][21][22][23]. It also appears that severely obese patients are predisposed to a greater number of cardiovascular risk factors, known as the metabolic syndrome [24]. ...
Severe obesity defined as BMI value corresponding to an adult > 40 kg/m² affects 1–5% of children and adolescents in Europe. The purpose of this study was to assess the occurrence of cardiovascular risk factors in children and adolescents with severe obesity. The analysis included 140 patients (75 female) at the mean age of 14 ± 2.1 SD (range 10–18) years (all recruited in 4 regional reference centers in Poland). Severe obesity was defined as BMI > 35 kg/m² (children 6–14 years), and BMI > 40 kg/m² (> 14 years). Fasting plasma samples have been obtained in all patients, and OGTT was performed in all patients. The metabolic risk factors were defined as high blood pressure (BP > 90 percentile for height, age, and sex), HDL cholesterol < 1.03 mmol/L, TG ≥ 1.7 mmol/L, and hyperglycemic state (fasting blood glucose > 5.6 mmol/L, or blood glucose 120′ after oral glucose load > 7.8 mmol/L). Additionally, the MetS z-score was calculated using Metabolic Syndrome Severity Calculator. One hundred twenty-four (89%) participants presented with high BP, 117 (84%) with abnormal lipid profile, and 26 with the hyperglycemic. Only 12 (9%) were free of metabolic complications. More than 60% of patients had more than one cardiovascular risk factor. The high BP was significantly associated with the severity of obesity (F = 9.9, p = 0.002). Patients with at least one metabolic complication presented with significantly younger age of the onset of obesity (the mean age of the patients with no overt obesity complications was 10 years, while the mean age of those who presented at least one was 4.7 ± 3.5 SD years (p = 0.002)). A significant positive association between in the value of the Mets BMI z-score with age was observed (R = 0.2, p < 0.05). There were no differences between girls and boys regarding Mets BMI z-score (1.7 ± 0.8 vs 1.7 ± 0.7, p = 0.8).
Conclusions: The most common metabolic risk factor in children and adolescents with severe obesity was high BP. The most important factor determining presence of obesity complications, and thus the total metabolic risk, seems to be younger (< 5 years) age of onset of obesity. What is Known?
• It is estimated that 1-5% of children and adolescents in Europe suffer from severe obesity corresponding to an adult BMI > 40 kg/m2, and it is the fastest growing subcategory of childhood obesity.
• Children with severe obesity face substantial health risk that may persist into adulthood, encompassing chronic conditions, psychological disorders and premature mortality.
What is new:
• The most common complication is high BP that is significantly associated with the severity of obesity (BMI z-score), contrary to dyslipidemia and hyperglycemic state, which do not depend on BMI z-score value.
• The most important factor determining presence of obesity complications, and thus the total metabolic risk, seems to be younger (< 5 years) age of onset of obesity.
... The prevalence of childhood obesity continues to rise and approximately one in five children in the U.S. were obese between 2017 and 2020 [1]. Early infant growth has been linked to long-term health, as rapid early weight gain has been associated with a greater risk of coronary heart disease and diabetes [2][3][4]. One of the most important modifiable factors associated with early growth and later an overweight status and obesity is the type of infant feeding [5]. ...
Early infant growth trajectories have been linked to obesity risk. The aim of this study was to examine early infant feeding practices in association with anthropometric measures and risk of overweight/obesity in childhood. A total of 2492 children from Upstate KIDS, a population-based longitudinal cohort, were included for the analysis. Parents reported breastfeeding and complementary food introduction from 4 to 12 months on questionnaires. Weight and height were reported between 2 and 3 years of age and during later follow-up at 7–9 years of age. Age and sex z-scores were calculated. Linear mixed models were conducted, adjusting for maternal and child sociodemographic factors. Approximately 54% of infants were formula-fed at <5 months of age. Compared to those formula-fed, BMI- (adjusted B, −0.23; 95% CI: −0.42, −0.05) and weight-for-age z-scores (adjusted B, −0.16; −0.28, −0.03) were lower for those exclusively breastfed. Infants breastfed for ≥12 months had a lower risk of being overweight (aRR, 0.33; 0.18, 0.59) at 2–3 years, relative to formula-fed infants. Compared to introduction at <5 months, the introduction of fruits and vegetables between 5 and 8 months was associated with lower risk of obesity at 7–9 years (aRR, 0.45; 0.22, 0.93). The type and duration of breastfeeding and delayed introduction of certain complementary foods was associated with lower childhood BMI.
... Low birth weight (LBW) (any live birth under 2500 g, newborn under 2500 g) and preterm birth (<37 weeks gestation) have emerged as predisposing factors of mortality as well as of cardiovascular, renal, and metabolic morbidities in adulthood [3,4]. High birth weight (HBW) (newborn over 4000 g) may also represent a risk or vulnerability factor predisposing to adultonset diseases, including cancer [5], although the risk of cardiovascular and renal disease for HBW participants remains unproven [6][7][8]. ...
Objective:
Although preterm-born and low-birth-weight individuals have an increased risk of cardiovascular diseases in adulthood, little is known regarding early cardiovascular and renal damage (CVRD) or hypertension in adulthood. Our study investigated the association of birth weight with early CVRD markers as well as the heritability of birth weight in an initially healthy family-based cohort.
Methods:
This study was based on 1028 individuals from the familial longitudinal STANISLAS cohort (399 parents/629 children) initiated in 1993-1995, with a fourth examination conducted in 2011-2016. Analyses performed at the fourth visit included pulse-wave velocity, central pressure, ambulatory blood pressure, hypertension status, diastolic dysfunction/distensibility, left ventricular mass indexed (LVMI), carotid intima-media thickness and kidney damage. The family structure of the cohort allowed birth weight heritability estimation.
Results:
Mean (±SD) birth weight was 3.3 ± 0.6 kg. Heritability was moderate (42-44%). At the fourth visit, individuals were 37 years old (32.0-57.0), 56% were women and 13% had antihypertensive treatment. Birth weight was strongly and negatively associated with hypertension [odds ratio (OR) 95% confidence interval (CI) 0.61 (0.45-0.84)]. A nonlinear association was found with LVMI, participants with a birth weight greater than 3 kg having a higher LVMI. A positive association (β 95% CI 5.09 (1.8-8.38)] was also observed between birth weight and distensibility for adults with normal BMI. No associations were found with other CVRD.
Conclusion:
In this middle-aged population, birth weight was strongly and negatively associated with hypertension, and positively associated with distensibility in adults with normal BMI and with LVMI for higher birth weights. No associations were found with other CVRD markers.
... In young adults, each 1-kg/m 2 increase in BMI was associated with a 6% higher risk of developing type 2 diabetes before the age of 45 years (15). In a cohort of Danish and Finnish subjects, each z-score increase in BMI at 7 years of age (equivalent to a 1.5 to 2.5 kg/m 2 increment) was associated with a 5%-10% greater risk of coronary heart disease in adulthood (16). Moreover, the risk of mortality increases significantly throughout the overweight and obesity range. ...
Context
Severe childhood obesity is associated with increased prevalence of cardiometabolic risk factors (CMRFs). Among children with Class 1 obesity, higher BMI may indicate greater cardiometabolic risk. Class 1 obesity reflects a wide spectrum of BMI values. Each 10% increase in BMI above the 95th percentile is equivalent to an average increase of 2.15 kg/m2 and 2.75 kg/m2 in BMI among children and adolescents, respectively. Such increments may be of clinical importance.
Objectives
The study aimed to determine the prevalence and clustering of CMRFs in children and adolescents with BMI 110%-119% of the 95th BMI percentile.
Methods
A cross-sectional analysis of data, from an Israeli health maintenance organization, of children and adolescents (5-17 years) with overweight or Class 1 obesity, and at least one measurement of lipid profile during Jan/2020-May/2021. CMRFs were defined as abnormal lipid profile, elevated alanine aminotransferase, hypertension, and prediabetes or diabetes. Study groups included overweight and Class 1 Obesity-A (BMI < 110%) and Obesity-B (BMI ≥ 110%) of the 95th BMI percentile.
Results
Of 7211 subjects included, 40.2% were overweight, 50.3% obesity-A, and 9.5% obesity-B. Multivariable analyses showed that children and adolescents from the Obesity-B group had increased odds for higher triglycerides, LDL cholesterol, and ALT levels; and lower HDL cholesterol levels, as compared to Obesity-A. The odds of prediabetes (insignificant) tended to be higher in the Obesity-B group, which was associated with increased CMRFs clustering.
Conclusions
Among children and adolescents with Class 1 obesity, BMI ≥ 110% of the 95th percentile was associated with higher prevalence and clustering of CMRFs.
... Catch-up growth refers to a rapid compensatory gain of anthropometry (i.e., upward crossing weight centiles) and BC parameters occurring during infancy in LBW infants (25). Evidence is mounting to show that rapid catch-up growth, characterized by an increase in fat storage or an increase in BMI, leads to the development of higher blood pressure, insulin resistance, and cardiovascular risk already in childhood (26). According to the "thrifty phenotype" hypothesis, this rapid and marked fat accumulation improves thermoregulation, increases body energy stores allowing a better adaptation to the extrauterine life, and is regulated both by several endocrine factors (i.e., IGF-1, leptin, adiponectin) and early life nutrition (27,28). ...
Preterm newborn infants are characterized by low body weight and lower fat mass at birth compared with full-term newborn neonates. Conversely, at term corrected age, body fat mass is more represented in preterm newborn infants, causing a predisposition to developing metabolic syndrome and cardiovascular diseases in later life with a different risk profile in men as compared with women. Postnatal growth is a complex change in anthropometric parameters and body composition. Both quantity and quality of growth are regulated by several factors such as fetal programming, early nutrition, and gut microbiota. Weight gain alone is not an optimal indicator of nutritional status as it does not accurately describe weight quality. The analysis of body composition represents a potentially useful tool to predict later metabolic and cardiovascular risk as it detects the quality of growth by differentiating between fat and lean mass. Longitudinal follow-up of preterm newborn infants could take advantage of body composition analysis in order to identify high-risk patients who apply early preventive strategies. This narrative review aimed to examine the state-of-the-art body composition among born preterm children, with a focus on those in the pre-school age group.
... However, rapid "catchup" growth (i.e., an upward crossing of weight centiles) or increase in BMI leads to the development of higher blood pressure, insulin resistance, and cardiovascular risk already in childhood. These findings are most marked in those who were born small and became relatively larger (28). ...
Low weight at birth may be due to intrauterine growth restriction or premature birth. Preterm birth is more common in low- and middle-income countries: 60% of preterm birth occur in sub-Saharan African or South Asian countries. However, in some higher-income countries, preterm birth rates appear to be increasing in relation to a reduction in the lower threshold of fetal viability. The cutoff is at 22–23 weeks, with a birth weight of approximately 500 g, although in developed countries such as Japan, the viability cutoff described is 21–22 weeks. There is evidence of the long-term consequences of prenatal programming of organ function and its relationship among adult diseases, such as hypertension (HT), central obesity, diabetes, metabolic syndrome, and chronic kidney disease (CKD). Premature delivery before the completion of nephrogenesis and intrauterine growth restriction leads to a reduction in the number of nephrons that are larger due to compensatory hyperfiltration and hypertrophy, which predisposes to the development of CKD in adulthood. In these patients, the long-term strategies are early evaluation and therapeutic interventions to decrease the described complications, by screening for HT, microalbuminuria and proteinuria, ultrasound monitoring, and renal function, with the emphasis on preventive measures. This review describes the effects of fetal programming on renal development and the risk of obesity, HT, and CKD in the future in patients with low birth weight (LBW), and the follow-up and therapeutic interventions to reduce these complications.
... Previous studies have reported associations between a high birthweight and adult obesity as well as metabolic disease, [3][4][5][6] while others instead indicate beneficial effects of a high birthweight. 5,7,8 However, few studies on adult health have isolated subjects with a very high birthweight (>3 SDS) from those with a moderately high birthweight (2)(3). 6 This distinction might be of interest since data from our group indicate that subjects with a very high birthweight differ from those with a moderately high birthweight with respect to risk of adult disease. ...
... 7 Furthermore, the risk of coronary heart disease has been reported to be lower for individuals with a moderately high birthweight compared with those with birthweights between 3 and 4 kg. 8 A major strength of this study was the use of a nationwide register with high coverage, making it possible to analyze birthweight subgroups separately. The register also provides a possibility to study intergenerational effects, related to pregnancy and the perinatal period. ...
This study aimed to investigate how maternal birthweight is related to early pregnancy obesity, gestational diabetes mellitus (GDM), and offspring birthweight. Females born term and singleton in Sweden between 1973 and 1995 (N = 305,893) were studied at their first pregnancy. Information regarding their birthweight, early pregnancy body mass index, and pregnancy complications was retrieved from the Swedish Medical Birth Register, as were data on their mothers and offspring. High maternal birthweights (2–3 standard deviation scores (SDS) and >3 SDS) were associated with greater odds of early pregnancy obesity, odds ratio (OR) 1.52 (95% confidence interval (CI) 1.42–1.63) and OR 2.06 (CI 1.71–2.49), respectively. A low maternal birthweight (<2 SDS) was associated with greater odds of GDM (OR 2.49, CI 2.00–3.12). No association was found between high maternal birthweight and GDM. A maternal birthweight 2–3 SDS was associated with offspring birthweight 2–3 SDS (OR 3.83, CI 3.44–4.26), and >3 SDS (OR 3.55, CI 2.54–4.97). Corresponding ORs for a maternal birthweight >3 SDS were 5.38 (CI 4.12–7.01) and 6.98 (CI 3.57–13.65), respectively. In conclusion, a high maternal birthweight was positively associated with early pregnancy obesity and offspring macrosomia. A low, but not a high maternal birthweight, was associated with GDM.
... The 3-year follow-up of the children's BMI suggested that being born at LBW or macrosomia increases the risk of being in the low or high BMI percentiles until 3 years of age, respectively. Importantly, small size at birth per se is well known to be associated with early adiposity rebound, obesity, and metabolic syndrome [45][46][47][48][49]. Although, the present study was able to analyze the children's BMI until 3 years of age, further observations of the children's cohort may show the prevalence of early adiposity rebound in LBW infants and the relationship between LBW and the future prevalence of obesity and its comorbidities. ...
Objective
Both maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) influence maternal and pediatric outcomes. We sought to clarify the impact of prepregnancy BMI-specific GWG and its patterns on the risk of low birth weight (LBW) or macrosomia using data from a large nationwide study in Japan.
Methods
This cohort study ( n = 98,052) used data from the Japan Environment and Children’s Study (JECS). The outcome variables in this study were LBW and macrosomia. We stratified the subjects into groups according to prepregnancy BMI.
Results
GWG from pre-pregnancy to the first trimester had a small effect on the risk of LBW and macrosomia. From the first to second trimesters, insufficient GWG was associated with the risk of LBW, and from the second trimester to delivery, a GWG of less than 2 kg was associated with the risk of LBW. These associations were commonly observed in all prepregnancy BMI categories. Irrespective of the GWG from pre-pregnancy to the first trimester, GWG from the first to second trimesters affects LBW and/or macrosomia. Irrespective of the GWG from the first to second trimesters, GWG from the second trimester to delivery affects LBW and/or macrosomia. LBW or macrosomia was associated with the prevalence of a sustained low or high BMI percentile until three years of age, respectively.
Conclusions
The present large national cohort study indicates that the risk of LBW or macrosomia is associated with GWG in women in Japan; the significance of this risk depends on the GWG patterns.
... Multiple studies have since corroborated Dr Barker's findings with either an inverse relationship or a U-shaped relationship between birth weight and cardiovascular disease. [44][45][46][47] The increased risk in cardiovascular disease associated with low birth weight was due to failure to achieve growth potential and not due to low birth weight from prematurity. 48,49 Importantly the impact of birth weight on cardiovascular complications was independent of socioeconomic status, confirming intrauterine growth as a marker of life-long cardiovascular health. ...
Fetal growth restriction (FGR) describes a fetus' inability to attain adequate weight gain based on genetic potential and gestational age and is the second most common cause of perinatal morbidity and mortality after prematurity. Infants who have suffered fetal growth restriction are at the greatest risks for short- and long-term complications. This article specifically details the neurologic and cardiometabolic sequalae associated with fetal growth restriction, as well as the purported mechanisms that underlie their pathogenesis. We end with a brief discussion about further work that is needed to gain a more complete understanding of fetal growth restriction.
... A study on Danish and Finnish cohorts found an independent, strongly positive association between BMI at age 7 and coronary artery disease in adulthood [68]. In a cohort study of 37,000 career army personnel, Tirosh et al. showed that adolescent obesity was associated with incident angiographyproven coronary heart disease later in life independently of adult BMI [17] (Fig. 2). ...
Purpose of Review
Rates of childhood obesity have been soaring in recent decades. The association between obesity in adulthood and excess morbidity and mortality has been readily established, whereas the association of childhood and adolescent obesity has not. The purpose of this review is to summarize existing data regarding the association of the presence of obesity in childhood/adolescence and early-onset adverse outcomes in adulthood, with specific focus on young adults under the age of 45 years.
Recent Findings
Diabetes, cancer, and cardiometabolic outcomes in midlife are closely linked to childhood and adolescent obesity.
Summary
Childhood and adolescent obesity confer major risks of excess and premature morbidity and mortality, which may be evident before age 30 years in both sexes. The scientific literature is mixed regarding the independent risk of illness, which may be attributed to childhood BMI regardless of adult BMI, and additional data is required to establish causality between the two. Nonetheless, the increasing prevalence of childhood and adolescent obesity may impose an increase of disease burden in midlife, emphasizing the need for effective interventions to be implemented at a young age.
